I. Overview of Chief Minister-gi Hakshelgi Tengbang (CMHT)
Chief Minister-gi Hakshelgi Tengbang (CMHT) is a pioneering health assurance scheme initiated by the Government of Manipur. The Scheme will provide Cashless treatment to the poor at Empanelled Network of Hospitals in Manipur and Guwahati and give health cover worth up to Rs. 5 Lakh per eligible family per year.
1. Objectives of CMHT
The Scheme will cover secondary and tertiary care on Hospitalization at the empanelled network of Hospitals.
Within the state: Under the Scheme, treatment will be available at 9 District Hospitals(2 Medical college hospitals -RIMS & JNIMS) | CHC (Wangoi, Saikul, Kakching, Sugnu and Sekmai), PHC Maram and UHC Singjamei|Moreh Hospital and other empanelled private hospitals.
Outside the state: Treatment will also be available at Narayana Super specialty Hospital, Guwahati.
2. Eligible Beneficiaries under the Scheme
- Widows, Disabled and AAY cards holder will be eligible for the scheme.
- Local Media Person & Newspaper hawkers
- Newly added to State SECC (identified through DC verification process)
- ASHA Workers
- Anganwadi Workers
- Anganwadi Helpers
- Ima Market Woman Vendors
3. Enrollment and Issuance of Card
- Eligible families need to get enrolled on the scheme by producing mandatory documents.
- Each eligible beneficiary family will receive a CMHT - Manipur Health card with a unique identification number.
- Names of up to 5 members of the family will be printed on the card. If there are more than 5 members, then the additional member's count will be written next to the 5th name (Eg. 2 more, 1 more, 3 more and soon)
4. Mandatory Documents Required for Enrollment:
- ID Proof: Original Ration Card /Aadhaar Number.
- Eligibility Proof: AAY card / Disability certificate / Widow- Proof certificate (Death Certificate of the husband) /Certificate from Deputy Commissioner regarding eligible economic status / ASHA Workers-Membership letter from State Health Society (NHM), Manipur/ Anganwadi Workers and Helpers- Membership letter from Social Welfare Department, Manipur/ Ima Market Woman Vendors- Membership letter from Imphal Municipal Corporation/ any other documents approved as eligible for the scheme by Government of Manipur. Any one of the above is acceptable as eligibility proof. For Local Media person & Newspaper hawkers authorised Agency’s ID card is enough.
- Aadhaar Number: To enrol in the scheme, the Aadhaar number is essential and a copy of the Aadhaar card is to be shared along with a consent note. At least, one member of the family must provide Aadhaar credentials for enrolling the family.
- If the beneficiary is not having an Aadhaar card but still wants enrolment in the scheme, he/she has to get enrolled into Aadhaar and provide the Aadhaar application number and consent form.
- Optional Documents: Any document which is notified as acceptable and issued by the Government of Manipur.
- Declaration form for unemployment in Government service to be filled up at the counter before making the card by the beneficiary.
5. Benefits under the Scheme
- By showing a CMHT-Manipur Health card, a beneficiary can get cashless treatment i.e. without making any payment to the empanelled hospitals up to Rs. 5 Lakh per year per enrolled family on a floater basis. The benefit will be applicable to certain day-care and hospitalization procedures only.
- The total benefit will be admissible up to the ceiling amount of Rs 5 Lakh per year per family including transport and daily allowances.
6. Empanelled Hospitals
Within the state: CHC (Kangpokpi, Wangoi, Haoreibi, Mao, Moirang, Nambol, Saikul, Kakching, Sekmai, Parbung, Heirok, Kamjong, Chakpikarong, Sagolmang, Nungba and Yairipok), PHC Maram and UHC Singjamei | Moreh Hospital |District Hospitals | RIMS | JNIMS and other empanelled private Hospitals are implementing of CMHT Manipur Scheme.
Outside the state: Treatment will also be available at Narayana Super specialty Hospital and Midland Hospital Guwahati.
The beneficiary will be offered the option to choose hospitals within the State in the first instance, provided there is the availability of capacity and the treatment procedure.
"Health Coordinator" appointed by the ISA at the empanelled Hospitals, within the State, will guide the beneficiary, from enrollment to admission until discharge.
II. Implementation of CMHT
1. State Nodal Cell (SNC)
State Nodal Cell (SNC) has been set up by the Government of Manipur for the implementation of the Scheme. SNC will support implementation by the ISA and supervise the Scheme.
2. Implementation Support Agency (ISA)
Medi Assist Insurance Pvt. Ltd. a TPA has been selected by the SNC through an open and transparent tender process to support the execution of the following activities of the Scheme:
- Enrollment of beneficiaries.
- Establish an Enrollment Kiosk cum Claims Help Desk at all the District Hospitals | RIMS | JNIMS| Wangoi CHC.
- Empanelling hospitals.
- Deployment of Health Coordinators at empanelled Public hospitals within the State to facilitate the beneficiaries and ensure that effective treatment is extended to the beneficiary patients without any hassle.
- Provide software access to the hospitals for IT based management of the scheme besides ensuring that the empanelled hospitals set up the infrastructure and follow the duly agreed processes.
- Ensuring that the beneficiaries are provided cashless treatment at empanelled hospitals including processing and verification of bill details and then forwarding them to SNC through ISA for making payment to the hospitals.
- Quality Audit of the empanelled hospitals from time to time as agreed in the contract with the SNC.
- Set up a 24x7 Call Centre to help beneficiaries get timely support and clarifications. The Toll-Free Number Registered for CMHT - Manipur is 1800 103 2015
- Timely redressal of grievance received at Call Center as well as at the field level in collaboration with SNC
III. Roles & Responsibilities
The overall responsibility for the implementation of the scheme lies with the ISA. However, the positioning of responsible and designated District Officials will be necessary to coordinate and facilitate the work of the ISA to ensure the success of the Scheme under the overall guidance of the SNC.
1. Responsibilities of District Officials
The District team led by Deputy Commissioners in the districts will be responsible for ensuring that the Scheme is implemented by the ISA in a proper and robust manner. Each district will have a Nodal Officer in the rank of a District Community Mobiliser (DCM) to coordinate all activities related to the Scheme with the ISA. He/ She will be supported by designated Block and village Nodal officers.
- There will be a kick-off meeting chaired by the DCs in each District. A detailed enrollment and activity plan will be worked out and the key officials identified in consultation with the SNC.
- Space for setting up of the Enrollment Kiosks of the ISA will be allotted in all the enrollment counters in consultation with the Chief Medical Officer and Medical Officer in charge.
- Verifying Authorities (VAs) will be identified to verify and authenticate beneficiary credentials and documents as per Government of Manipur guidelines before enrolling the respective beneficiary family. All PHC MOs will nominate their respective VAs and the Medical Superintendent will nominate the VAs for RIMS and JNIMS.
- Will support the ISA to ensure the training of VAs, IT staff and other support staff at the district level.
- Deputy Commissioners will take the lead and guide in the organization of district workshops by the ISA.
- Will ensure adequate and appropriate publicity by the ISA through ASHA workers before the process of enrollment commences.
- During Enrollment
- Will monitor and ensure participation of VAs in the enrollment process at the enrollment counters.
- Will ensure specific publicity of the process for enrollment of eligible beneficiaries. To keep additional VAs in reserve in case the designated VAs at enrollment stations are absent/unable to perform duties.
- To provide support to ISA during enrollment by helping them in the coordination with stakeholders at the District, Block and Panchayat levels.
- To ensure that the VA submits the enrollment activity report on a weekly basis and the same is transmitted to the District Nodal Officers and other relevant officials at SNC.
- To review the performance of ISA with regard to the enrollment status through periodic review meetings.
2. Responsibilities of Health Coordinator
Health Coordinators are appointed by the ISA to facilitate beneficiaries from the time of enrollment/admission/hospitalization till discharge. The health Coordinator must act as a guide and friend for the prospective beneficiaries under the Scheme.
The ISA will post a Health Coordinator at each empanelled public hospital. It will ensure that the Health Coordinators are able to communicate effectively with the patients and their attendants.
Health Coordinators should be adequately trained and sensitized to the needs of the patients and their attendants.
The roles and responsibilities of Health Coordinators are as given below:
At the Empanelled Hospital
- In Case of enrollment at a Hospital Kiosk
- To maintain the Help Desk and Enrollment Kiosk at the reception area of the hospital.
- To enrol eligible beneficiaries who come for enrollment and distribute them the CMHT- Manipur Health Card.
- To register the claims of the un-eligible beneficiaries for enrollment and upload the same details to the respective Deputy Commissioner of the district for verification.
- Once the DC verifies the details, inform the beneficiary to visit and enrol at the nearest district hospitals
- In Case of availing benefits:
- To receive the patient.
- To verify the CMHT Health card and the documents of the patients.
- To facilitate consultation with the doctor and for admission.
- To coordinate with the designated Hospital Coordinator/Administrator.
- To counsel the patient regarding treatment/surgery /therapy.
- To facilitate early evaluation and posting for surgery/therapy.
- To ensure that the pre-authorization is correctly sent and followed upon approval.
- To facilitate discharge of the patient and obtain feedback.
- To counsel the patient regarding follow-up.
- To coordinate with the ISA and Medical Officers for any clarifications.
IV. Enrollment of Beneficiaries and how to avail Benefits at Empanelled Hospitals
For Eligible Beneficiaries
- AAY card
- Disability Certificate
- Widow (death certificate of husband),
- Local media person,
- Newspaper hawkers
- Newly identified other poor families (to be verified by the concerned Deputy Commissioner)
- ASHA Workers
- Anganwadi Workers
- Anganwadi Helpers
- Ima Market Woman Vendors
- Any other documents approved as eligible for the scheme by the Government of Manipur.
ISA will provide Village wise eligible beneficiary list along with a Scheme leaflet.
The Eligible Beneficiary will visit the nearest District Hospital along with mandatory documents to get enrolled.
All information regarding the scheme will be explained to the enrolled family.
Addition | Deletion of family members
For Un-Eligible Beneficiaries (Not in SECC database)
- In case any member got expired or had separated from the family, his/her name will be deleted from the Scheme enrolment list based on the Head of the family's recommendations.
How to avail benefits at Empanelled Hospitals
- If any beneficiary visits District Hospitals for enrollment, he/she will be treated well and his/her claim is registered by collecting all the documents (ID proof | Eligibility proof | Aadhar | Aadhar Consent form)
- The details will be captured in the software and the same will be uploaded to the respective Deputy Commissioners of the district for verification and approval.
- An SMS | Email notification will be sent to DC's for information.
- DCs will arrange the verification of the beneficiary details received and he/she will submit their recommendations.
- Based on the recommendations the beneficiary will be notified.
- If the respective beneficiary is eligible as per DCs recommendation they will be enrolled into the scheme and CMHT Health card will be issued by collecting eligible documents.
- Once the enrollment is completed the details will be forwarded to the SNC.
- Within the state: Beneficiaries who have CMHT Health Card can visit the nearest Empanelled Hospitals CHC (Kangpokpi, Wangoi, Haoreibi, Mao, Moirang, Nambol, Saikul, Kakching, Sekmai, Parbung, Heirok, Kamjong, Chakpikarong, Sagolmang, Nungba and Yairipok), PHC Maram and UHC Singjamei| Moreh Hospital |District Hospitals | RIMS | JNIMS and other empanelled private hospitals. The beneficiaries can connect to the Call Centre (Toll-free no. 1800-103-2015) which is a 24x7 service.
- Outside the state: Treatment will also be available at Narayana Super specialty Hospital, Guwahati and Midland Hospital Guwahati. The newly empanelled Narayana Superspeciality Hospital, Guwahati will provide free treatment for CMHT cardholders of Manipur in cardiology, general surgery, cardiac surgery, neurosurgery, nephrology, urology, orthopaedics, gastrology, and kidney related ailments and The newly empanelled Midland Hospital Guwahati will provide free treatment for CMHT cardholders of Manipur in Surgical oncology, Medical oncology, General surgery, obstetrics & gynecology, trauma, general medicine, neurosurgery, otorhinolaryngology, orthopedics, ICU care and supplemental procedures, pediatric surgery, neonatal care, genitourinary disease (kidney disease), gastroenterology and pathology.
- They have to present the CMHT Health Card along with ID proof of the respective beneficiary who requires treatment to the helpdesk.
- The Health Coordinator will verify and coordinate with Hospital coordinators to ensure that the patient gets cashless treatment.
- The Health Coordinator supports Hospital coordinators to submit Pre-authorization to ISA Processing Team through the Hospitalization portal provided by ISA.
- The Health Coordinator does the following for the pre-authorisation request sent by the hospital if it is approved and crossed TAT.
- Pre Authorization will be approved if all the details are corrected by the processing team.
- Ask for more information, in case the Hospital has not provided complete documents during the pre-authorization request.
- Deny if the treatment required is not listed as per the scheme conditions (Exclusion Policy).
- Once ISA Processing Team approves the pre-authorization, the treatment continues
- After successful completion of treatment, the Hospital will submit Claim documents through the Hospitalization portal provided by ISA.
- The Health Coordinator coordinates with the beneficiary and the Hospital for smooth treatment of the beneficiary during hospitalization.
- The Health Coordinator will take feedback from the beneficiary regarding the treatment availed at the time of discharge.
- The ISA Processing team will verify all the documents of claims and submit the float once a week or once a fortnight to SNC.
- SNC will verify all the details of claims processed by ISA and makes payment to respective Hospitals.
Note: In case of a treatment facility is not available at CHCs, PHC and UHC, the beneficiary will be referred to Sub District Hospital, District Hospitals, RIMS, JNIMS, Narayana Super specialty Hospital, Guwahati, Midland Hospitals or other empanelled network Hospitals respectively.